A drug distribution scheme which has been described as "a silver bullet" in the fight against malaria could actually be endangering lives, Oxfam has warned.
The Affordable Medicine Facility for malaria (AMFm), which is backed by the Global Fund to Fight AIDS, Tuberculosis and Malaria and is currently being piloted in seven countries, is potentially dangerous because it permits medicines to be distributed by unqualified shopkeepers and hawkers rather than trained health workers, the international agency warns, in a new report.
The AMFm has shown no concrete evidence that it has been effective at saving the lives of the most vulnerable, or in delaying drug resistance, the study adds.
"It is dangerous to put the lives of sick children in the hands of a shopkeeper with no medical training and to pursue a scheme that doesn't help those people who need it the most," said Dr Mohga Kamal Yanni, Oxfam's senior health policy adviser.
"A shopkeeper selling salt, pepper and malaria medicines cannot diagnose or treat a child with pneumonia," she added.
The AMFm was created to tackle malaria by subsidising the cost of artemisinin combination therapy (ACT), currently the most effective anti-malarial treatment, and promoting its sale through the private sector. But using untrained and unsupervised drug sellers poses a very high risk of misdiagnosis, given that malaria incidence is decreasing, and fevers are therefore likely to be due to other causes. Some studies show at 60% of fevers are not malarial, says Oxfam.
While a recent evaluation described the AMFm as a "game changer" that hasincreased availability and market share and decreased price, it gave no evidence of how many confirmed cases of malaria had been treated, the agency points out. The study also failed to measure concretely whether medicines were reaching the most vulnerable populations, such as children living in poor and remote areas, and it ignored evidence from countries like Ethiopia, where malaria deaths have halved in the last three years as a result of investment in community health workers, it says.
Moreover, it claims, the AMFm has caused excessive orders of ACT based on commercial interest rather than clinical need. For example, the private sector in Zanzibar ordered 150,000 treatments, yet the country reported fewer than 2,500 cases of malaria in a year, it reports.
Oxfam is calling for the Global Fund to "act on the evidence" and bring AMFm to an end at the Fund's board meeting on November 14-125.
"There is no cheap option or short cut to combat malaria. The AMFm is a dangerous distraction from genuine solutions like investing in community health workers, who have slashed the number of malaria deaths in countries such as Zambia and Ethiopia," said Dr Kamal Yanni.
However, a statement from the Fund described Oxfam's claims as untrue. While "some western aid groups oppose a pragmatic approach that includes any involvement of the private sector," the reality is that the AMFm is getting life-saving medicines to people who need it most from the private outlets where they already seek treatment, said the Fund. Before the scheme was launched three years, ago, life-saving malaria treatments were costing up to 20 times as much as they are now, it added.
The AMFm is also backed by the UK and Canadian governments, UNITAID and the Bill and Melinda Gates Foundation.